“They gave me a PrEP pill but they did not give me a pill to prevent pregnancy; I am now pregnant”. Non-Integrative approach in the Provision of PrEP for Adolescents and Young Adults in KwaZulu Natal, South Africa

<title>Abstract</title> <p>Introduction Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy; however, recent evidence indicates rising rates of unintended pregnancy and sexually transmitted infections (STIs) among adolescents using PrEP. This study examined the challenges associated with non-integrated PrEP delivery among adolescents and young adults (AYAs) in South Africa and explored opportunities for integrated, youth-friendly healthcare models. Methods In-depth interviews were conducted across 22 service delivery points (SDPs) in uMgungundlovu district, KwaZulu-Natal. Thirty-six HIV-negative AYAs (15–34 years) were purposively selected from a cohort of 2,772 high-risk, sexually active individuals who had recently tested HIV-negative and initiated PrEP within one month at clinics, schools, or community-based SDPs. Data were thematically analysed using inductive and deductive approaches. Results Key themes included missed opportunities for integrated care, structural and systemic fragmentation, preferences for integrated services, and perceptions of safety and risky behaviour. PrEP use was associated with reduced condom use and misconceptions that it prevents all STIs and pregnancy, contributing to increased STI risks and unintended pregnancies. Limited counselling, stigma, and judgmental provider attitudes constrained uptake and contributed to PrEP discontinuation. Participants strongly preferred integrated, youth-friendly, one-stop services combining PrEP with contraception, STI prevention, and broader sexual and reproductive health (SRH) services across facility, community, and school-based settings. Conclusion While PrEP effectively prevents HIV, non-integrated delivery may inadvertently increase vulnerability to STIs and unintended pregnancies. Integrating PrEP within comprehensive, youth-friendly SRH services is essential to prevent unintended health consequences, sustain PrEP use, and strengthen HIV prevention among adolescents.</p>